Rabies is a disease transmitted from animals to humans, which is caused by a virus. There are two clinical manifestations of rabies – frantic and paralytic. Frantic rabies is most common form of human rabies.

The rabies virus invades the nervous system of mammals. It is primarily transmitted from the rabid animal’s saliva when it bites or scratches someone. Licks to wounds or grazed and broken skin, or to the lining of the mouth and nose, can also transmit the disease.

Dogs are responsible for 96% of human rabies cases in South-East Asia, but there are also reports of human rabies due to bites of cats, mongooses, jackals, foxes,wolves and other carnivorous animals.Rabies due to monkey and rat bites are rare. Horses and donkeys get aggressive and bite ferociously when they are rabid. Cattle and buffaloes do not bite when they are rabid, but precautions should be taken while examing sick animals that are salivating.

Sometimes livestock owners confuse rabies with foot-and-mouth disease, haemorrhagic septicaemia or choking and may attempt to administer drugs by hand, and thus get infected with rabies virus.

There are no evidence-based reports of human rabies occurring due to consumption of milk. Individuals of professionals who slaughter rabies-infected animals and handle brain and other infected material may be at risk, but there are no human cases due to consumption of cooked meat.

Human-to-human transmission of rabies through corneal or other organ transplantation is rare but possible. Such transmission has occurred among recipients of trasnplated corneas and recently among recipients of solid organs and vascular tissue. Therefore corneas or organs should not be collected from a patient who died due to rabies encephalitis or any undiagnosed neurological disease.

Although rabies patients are extremely unlikely to bite other people, caregivers should be watchful and alert when looking after them, and avoid contact with the patient's saliva.

● Wounds should be washed and flushed immediately with soap and water for 10–15 minutes. If soap is not available, flush with water alone. This is the most effective first-aid treatment against rabies.

● Wounds should be cleaned thoroughly with 70% alcohol/ethanol or povidone-iodine, if available.

● As soon as possible, take the person to a healthcare facility for further treatment.

After entering the human body, the rabies virus progresses from the innermost layer of tissue below the human skin (called subcutaneous tissue), or from muscle, into peripheral nerves (i.e. the nerves in the body which are outside the brain or spinal cord). The virus migrates along nerves to the spinal cord and brain at an estimated speed of 12–24 mm a day. The infected person exhibits behavioural changes and clinical signs when the virus reaches the brain. The incubation period ranges from a few days to several months, and can be as long as 1 year.

● site of the bite – head and neck wounds, as well as wounds in highly innervated areas such as fingers, generally have shorter incubation periods due to the proximity of the viral inoculation to nerve tissue.

Human rabies caused by the classical rabies virus continues to be almost 100% fatal, with no specific treatment available anywhere in the world.

There are only seven recorded cases of human rabies survivors in the world, who received intensive nursing care. Almost all of them received preventive/ pre-exposure rabies vaccination that might have modified the course of illness. Only one case of human rabies caused by a bat bite did not receive pre-exposure vaccination but survived. However, this case was not caused by the classical rabies virus.

No. In countries where rabies is prevalent in a large population of dogs and cats, it is compulsory to start treatment and keep the biting dog/cat under 10 days of observation. If the animal remains healthy during the observation period then post-exposure prophylaxis (PEP) can be converted into pre-exposure regimen, i.e. the vaccine taken will be to prevent rabies if bitten in the future.

Post-exposure rabies prophylaxis (PEP) is compulsory if you are bitten by a dog, cat or other animal that is rabid or is suspected to be infected with rabies. PEP is required under following conditions:

● If the bite has broken the skin and the wound is bleeding.

● If a mucous membrane has been exposed to saliva from a suspect animal.

● If the animal that has bitten someone

1. is killed

2. disappears during the observation period

3. displays unusual, erratic behaviour

4. if laboratory tests of brain material from the suspected or rabid animal is positive.

Rat rabies has been reported from some Asian countries but is extremely rare. It is not necessary to take PEP in bite cases by house rats. However, it is prudent to take PEP in consultation with an infectious disease physician when bitten by wild rats/rodents.

There is no evidence-based information on human rabies cases due to bat exposure in the SouthEast Asia Region. However, there are reports of seropositivity against bat rabies virus in the bat population in Thailand. Therefore, it is recommended that you thoroughly wash the bite wound and consult an infectious disease physician. It is also recommended not to play with or handle sick or dead bats.

No. There is no laboratory or epidemiological evidence that the consumption of milk or milk products from rabid animals transmits the disease. However, it is not advisable to consume milk from rabid animals.

No. There is no single-dose rabies vaccine available anywhere in the world which can provide lifelong immunity. Single-dose vaccines are available, but they only provide immunity for a limited period of time.

Puppies are often obtained from reliable dog breeders where bitches are vaccinated against rabies. These puppies get maternal antibodies against rabies for 3 months and therefore it is recommended to vaccinate at 3 months of age, then at 9 months of age and revaccinate annually. Puppies and dogs must be given anthelmintic drugs regularly before vaccination.

If the puppies adopted are street dogs, the first vaccination should be given as the same protocol (at 3 months of age, 9 months, and yearly boosters). Alternately, first vaccination can be given as early as 2 months of age. Precautions should be taken in first 3 months of age.

If adult street dogs are adopted, then the first vaccination should be given as soon as possible, and a local veterinarian should be consulted.

No. All rabies vaccines for human use are inactivated. Human rabies vaccines undergo a series of quality control tests such as potency, toxicity, safety and sterility. It is not possible for the rabies vaccination to cause the disease.